The possibility of critical realist randomised controlled trials.

BACKGROUND: Some realists have criticised randomised controlled trials for their inability to explain the causal relations that they identify; to take into account the influence of the social context of the interventions they evaluate; and to account for individual difference. However, among realists, there is controversy over whether it is possible to improve trials by making them realist, or whether realism and the philosophical assumptions underlying trials are incompatible. This paper contributes to the debate in Trials on this issue. The debate thus far has concentrated on the possibility of combining trial methodology with that of realist evaluation. MAIN BODY: We concur with the contention that it is not feasible to combine randomised controlled trial design with the realist evaluation approach. However, we argue that a different variant of realism, critical realism, provides a more appropriate theoretical grounding for realist trials. In contrast to realist evaluation, which regards social mechanisms as an amalgam of social resources and people's reasoning, critical realism insists on their distinction. It does so on the basis of its assertion of the need to distinguish between social structures (in which resources lie) and human agency (which is at least partly guided by reasoning). From this perspective, conceiving of social mechanisms as external to participants can be seen as a valid methodological strategy for supplementing the exclusive concentration of trials on outcomes. While accepting realist evaluation's insistence that causality in open systems involves a configuration of multiple generative mechanisms, we adopt the critical realist interpretation of the experimental method, which sees it as creating artificial closure in order to identify the effects of specific causal mechanisms. If randomised controlled trials can be regarded as epidemiological proxies that substitute probabilistic controls over extraneous factors for closed experiments, their examination of the powers of discrete mechanisms through observation of the variation of outcomes is appropriate. CONCLUSION: While there are still issues to be resolved, critical realist randomised controlled trials are possible and have the potential to overcome some of the difficulties faced by traditional trial designs in accounting for the influence of social context and individual interpretation

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

European sourcebook of crime and criminal justice statistics – 2021

This is the sixth edition of a data collection initiative that started in 1993 under the umbrella of the Council of Europe and has been continued since 2000 by an international group of experts that created the European Sourcebook of Criminal Justice e.V.1 and is also a Working Group of the European Society of Criminology. These experts act as regional coordinators of a network of national correspondents whose contribution has been decisive in collecting and validating data on a variety of subjects from 42 countries.2 This edition of the Sourcebook is composed of six chapters. The first five cover the current main types of national crime and criminal justice statistics – police, prosecution, conviction, prison, and probation statistics – for the years 2011 to 2016, providing detailed analysis for 2015. The sixth chapter covers national victimization surveys, providing rates for the main indicators every five years from 1990 to 2015. As with every new edition of the Sourcebook, the group has tried to improve data quality as well as comparability and, where appropriate, increase the scope of data collection. For example, offence definitions were updated to reflect the lessons learned from previous editions.peer-reviewe

Sauropod dinosaur tracks from the Purbeck Group (Early Cretaceous) of Spyway Quarry, Dorset, UK

Dinosaur tracks have a long history of discovery and study in the UK, but track sites for sauropodomorph dinosaurs—the group that included the giant, graviportal herbivorous sauropods—are comparatively rare. Here, we provide a description of a sauropod dinosaur track site at Spyway Quarry in Dorset, southern England. The tracks at Spyway were discovered in the late 1990s and occur in the Stair Hole Member of the Durlston Formation in the Purbeck Limestone Group, of earliest Cretaceous age. More than 130 individual tracks of large sauropod dinosaurs are present at the site, but they are generally poorly preserved and do not form clear trackways, although it is likely that they represent multiple individuals. They provide further evidence for sauropods living in or passing through coastal lagoonal environments. Although poorly preserved, Spyway represents the largest in situ dinosaur track site currently accessible within the Purbeck Group with considerable potential for further discoveries through ongoing quarrying in the surrounding area

3D model-2021 Spyway Quarry, Dorset, UK

[1] 3D model of Spyway Quarry in 2021 (.obj, .png and .mtl files) [2] Raw photos used in the 2021 Spyway Quarry 3D model. These data underpin the manuscript "The condition, use and future of the UK’s largest accessible dinosaur tracksite at Spyway Quarry, Dorset" accepted for publication in Proceedings of the Geologists' Association by Edgar et al. (2023